Provider Demographics
NPI:1720366164
Name:PROSPINAL INC
Entity Type:Organization
Organization Name:PROSPINAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-336-3472
Mailing Address - Street 1:630 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2356
Mailing Address - Country:US
Mailing Address - Phone:775-336-3472
Mailing Address - Fax:775-284-4902
Practice Address - Street 1:630 SIERRA ROSE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2356
Practice Address - Country:US
Practice Address - Phone:775-336-3472
Practice Address - Fax:775-284-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty